Which finding is more characteristic of chronic DVT on ultrasound?

• A. Hyperechoic thrombus with contracted vein and collaterals present
• B. Incompressible vein with dilated lumen
• C. Hypoechoic thrombus with poor collaterals
• D. Recanalization of the vessel with no thrombus

Answer: (A)

Chronic DVT on ultrasound is best recognized by a thrombus that has become organized and echogenic, along with changes in the vein due to long-standing occlusion. The clot appears bright (hyperechoic) because it has fibrotic tissue, the vein often looks contracted from scarring, and collateral vessels develop to bypass the blocked segment. This combination—bright thrombus, a narrowed or contracted vein, and visible collaterals—is characteristic of a long-standing thrombus. In contrast, acute DVT more commonly shows an enlarged, incompressible vein with a potentially hypoechoic or less organized clot and fewer collaterals, while recanalization with no thrombus reflects resolution rather than chronic occlusion.